Since osseous healing in the fracture of the femoral neck is carried out by endosteal bone formation, the size of contact area of the fracture fragments and impaction are of prime importance. It is not uncommon to be faced with the problem of back out of the internal fixation devices during healing period. It seems unnecessary to emphasize the benefit of sliding to close the gap between the fracture fragments. We report a retrospective study of 25 cases of the femoral neck fractures treated by closed reduction and fixation with multiple Knowles pins, paying particular attention to the amount and duration of sliding back out of the fixation devices and relating these to the final results of fracture union. Our clinical study led us to the following conclusions; 1. The shortoning of the femoral neck over 3mm occurred in 16 cases(64%) out of 25 cases. The average amount of back out of Knowles pin is 6mm. 2. Most of the shortening occurred during the first 8 weeks after surgery and extrusion of the nail is frequent findings in unstable fractures and osteoporoses. 3. Backing out over 12 weeks after surgery was associated frequently with delayed union and non-union. 4. Collapse or shortening is nceessary to promote a bone to bone contact and bone healing.
Clinical Study ; Femoral Neck Fractures ; Femur Neck ; Internal Fixators ; Osteogenesis ; Osteoporosis ; Retrospective Studies

BACKGROUND: Thyroid nodules are among the most common endocrine diseases requiring surgical treatment. To determine the appropriate treatment methods for thyroid nodules, we conducted this study by analyzed the clinical characteristics of thyroid nodules, the surgical procedure, and postoperative complications. METHODS: We experienced 39 cases of thyroid nodules below 1 cm in size and treated them by surgical intervention at the Department of Surgery, Masan St. Mary's Hospital, from April 1994 to June 1996. We examined the age and the sex distributions, the clinical manifestations, the locations of the thyroid nodules, the pathologic findings, the ultrasonographic findings, the aspiration biopsy cytology findings, the surgical procedures, and the postoperative complications. RESULTS: 1) The mean age of the patients was 45 years, and the sex ratio of males to females was 1:18.5. 2) The nodules were located in the right lobe (24 cases), the left lobe (10 cases), both lobes (3 cases), isthmus (2 cases). 3) When 39 cases were examined by ultrasonography, the malignant nodules were found in 1 of 14 cases of anechoic nodules and 10 of 25 cases of isoechoic nodules. 4) Aspiration biopsy cytology was performed in 21 cases, and the false negativity was 25%, the false positivity was 25%, and the accuracy rate was 75%. 5) The histopathologic classification of the benign nodules were follicular adenomas, 13 cases; adenomatous goiters, 12 cases; Hashimoto's thyroiditis, 1 case; Hurthle cell adenoma, 1 case; and simple cyst, 1 case. The malignant diseases were papillary carcinoma, 10 cases; and follicular carcinoma, 1 case. 6) Most cases of benign nodules were treated with a lobectomy (72.4%). Malignant nodules were treated with an extended lobectomy and anterior compartment node dissection. 7) The major postoperative complication was transient hypocalcemia. CONCLUSIONS: When voice change or hoarseness is observed and a thyroid nodule is suspected on ultrasonography, aspiration biopsy cytology is considered to be required to exactly distinguish benign nodules from malignant nodules. Further, in case of malignant nodules, it can be concluded that a more active and careful operation may be required to minimize the complications, to decrease the recurrence rate, and to increase the survival rate.
Adenoma ; Biopsy, Needle ; Carcinoma, Papillary ; Classification ; Endocrine System Diseases ; Female ; Goiter ; Hoarseness ; Humans ; Hypocalcemia ; Male ; Postoperative Complications ; Recurrence ; Sex Distribution ; Sex Ratio ; Survival Rate ; Thyroid Gland* ; Thyroid Nodule* ; Thyroiditis ; Ultrasonography ; Voice

Recent immunological investigations have demonstrated that the patients with psoriasis have various humoral and cellular immune abnormalities, such as increased serum IgG, IgE and secretory IgA, anti-IgC factor in psoriatic lesions, in peripheral blood lymphocytes and in serum, rhumatoid-like factors in IgA and IgG classes of immunoglobulins, antinuclear antibodies (ANA; reacting with the basal cell nuclei of uninvolved skin., anti-stratum corneum antibody and complements in psoriatic scales, immuoglobulin and complement bearing polymorphonuclear leucocytes in the Muro microabscess. These abnormal findings are enough to suggest an autoimmune mechanism in the pathogenesis of psoriasis. Several investigators have also reported the results of T cell enumeration in the peripheral blood in psoriatic patients. However, the results are not in general agreement,. Thee present study was undertaken to clarify any abnormality in the proportion of T cells in the peripheral blood in psoriatic patients. Forty-one patients with active psoriasis registered at the Department of Dermatology, Seoul National University Hospital entered this study from May, 1979 through April, 1980. Twelve healthy medical and paramedical personel the comprised the control group. Active and total T cells were enumerated by the method of E-rosetting technique, and the results were as follows. 1, in normal controls, the active and total T celIs identified as E rosetteforming cells accounted for 61.6+7.4% and 68.1+8.9% of the total lymphocyte population, respectively. 2. In patients with psoriasis, significant decrease of active T cells (54. 2,+11.0%,p<0.005) and total T cells (62.2+11.2%, p<0.05) was observed. More profound reduction of T cells was noted in patients with wide spread psoriasis than those with limited extent.
Antibodies, Antinuclear ; Cell Nucleus ; Complement System Proteins ; Dermatology ; Humans ; Immunoglobulin A ; Immunoglobulin A, Secretory ; Immunoglobulin E ; Immunoglobulin G ; Immunoglobulins ; Lymphocytes ; Psoriasis* ; Research Personnel ; Seoul ; Skin ; T-Lymphocytes* ; Weights and Measures

We analysed the optic nerve head of 151 normal eyes with 8 confocal scanning laser ophthalmoscope (TopSSTM, Laser Diagnostic Technologies, Inc.), and obtained the normal values of each parameters. As the optic disc size increases, the cup shape, effective area, 1/2 depth area, C/D ratio, neuroretinal rim area, volume above, volume below, and 1/2 depth volume also increase. Therefore we obtained the normal values of these parameters according to the optic disc size. The entire subjects were divided into four groups according to the disc area, each group of 1. 5mm2-2.0mm2, 2.0mm2-2.5mm2, 2.5mm2-3.0mm2, and 3.0mm2-3.5mm2`, respectively. The normal values of other parameters such as contour variation, rnean contour depth, average depth, maximum depth, average slope, and maximum slope which are not affected by optic disc size were obtained without grouping. This may minimize the error in evaluating the optic disc parameters and may be useful in the early detection of glaucomatous optic disc changes.
Ophthalmoscopes ; Optic Disk ; Reference Values*

Pneumocystis pneumonia (PCP) is caused by the yeast-like fungus Pneumocystis jirovecii, which is specific to humans. PCP could be a source of opportunistic infection in adults that are immunosuppressed and children with prematurity or malnutrition. The diagnosis should be confirmed by identification of the causative organism, by analysis of the sputum, a bronchoalveolar lavage or a tissue biopsy. In both histologic and cytologic specimens, the cysts are contained within frothy exudates, which form aggregated clumps. The cysts often collapse forming crescent-shaped bodies that resemble ping-pong balls. We recently diagnosed nine cases of PCP using an immunohistochemical stain for Pneumocystis. The patients consisted of five human immunodeficiency virus positive individuals, two renal transplant recipients, and two patients with a malignant disease. All nine patients were infected with P. jirovecii, which was positive for monoclonal antibody 3F6. In conclusion, the immunohistochemical stain used in this report is a new technique for the detection of P. jirovecii infection.
Adult ; Biopsy ; Bronchoalveolar Lavage ; Child ; Exudates and Transudates ; Fungi ; HIV ; Humans ; Immunohistochemistry ; Malnutrition ; Opportunistic Infections ; Pneumocystis ; Pneumocystis jirovecii ; Pneumonia, Pneumocystis ; Sputum

We investigated the expression of CD99 in 35 hyperplastic perigastric lymph nodes, which were resected for gastric carcinoma or chronic peptic ulcer. Essentially, all lymphocytes in lymph nodes expressed CD99, but there were two populations with respect to the intensity of CD99 expression--CD99high and CD99low cells. We showed CD99high cells were distributed in paracortical and medullary cords by immunohistochemical study while germinal center cells were CD99low. Using three-color flow cytometric analysis with CD3, CD4, CD8, CD19, CD23, CD45RA, CD45RO, CD69, CD138, IgM, IgD, and IgG, most of CD99high cells were shown to be activated/memory T cells. CD4+CD45RO+ T cells were the subset revealing the highest intensity of CD99 expression while CD4+CD45RA+ T cells were CD99low. Among B cells, IgG+ B cells revealed a higher level of CD99 molecules than IgM+ B cells. These results suggest that CD99 is one of activation-related molecules which are upregulated in recently activated lymphocytes.
Adult ; Aged ; Antigens, CD/analysis* ; B-Lymphocytes/immunology* ; Cell Adhesion Molecules/analysis* ; Flow Cytometry ; Germinal Center/immunology ; Human ; Immunohistochemistry ; Immunologic Memory/immunology* ; Lymph Nodes/immunology* ; Middle Age ; Peptic Ulcer/immunology* ; Stomach Neoplasms/immunology* ; T-Lymphocytes/immunology*

In the present study, the relationship among iron-availability, antibacterial activity, role of meconium as an iron source and the activity of bacterial iron-uptake system (IUS) for bacterial growth in amniotic fluid (AF) were investigated. Staphylococcus aureus ATCC 6538 and its streptonigrin-resistant (SR) mutant with defective IUS were used as the test strains. The growth of S. aureus in AF was stimulated dosedependently by addition of meconium. Bacterial growth stimulated by meconium was re-inhibited dose-dependently by addition of iron-chelator, dipyridyl and apotransferrin. Iron concentration was correlated with the meconium content in AF (r(2)= 0.989, p=0.001). High-affinity IUS of S. aureus was expressed only in AF but not in AF with meconium. The growth of SR strain was more retarded than that of the parental strain in the iron-deficient brain heart infusion (ID-BHI), clear AF and AF containing apotransferrin. The retarded growth of both strains in the ID-BHI and AF was recovered by addition of holotransferrin, hemoglobin and FeCl3. Taken together, the antibacterial activity of AF is closely related with low iron-availability. Bacterial growth in AF considerably depends on the activity of bacterial IUS. Meconium acts as one of the exogenous iron-sources and thus can stimulate bacterial growth in AF.
Amniotic Fluid/*microbiology ; Antibiotics, Antineoplastic/pharmacology ; Chelating Agents/pharmacology ; Dose-Response Relationship, Drug ; Female ; Ferric Compounds/pharmacology ; Human ; Iron/*metabolism ; Ligands ; Meconium/metabolism ; Mutation ; Pregnancy ; Pregnancy Trimester, Third ; Protein Binding ; Staphylococcus aureus/metabolism ; Streptonigrin/pharmacology ; Support, Non-U.S. Gov't ; Time Factors

To present a world-first case of a successful endovascular treatment of a celiomesenteric trunk (CMT) aneurysm. A 45-year-old man had an asymptomatic saccular aneurysm in a rare anomaly of CMT. Endovascular multiple micro-coil embolization of the common hepatic artery, splenic artery and the aneurysm was done, followed by a stent-graft deployment in the superior mesenteric artery covering the orifice to the aneurysm. Postoperative course was uneventful. Only 21 cases have been previously reported in the literature, and all were treated by open surgeries. Endovascular therapy can be safely done in selected cases of a CMT aneurysm with sufficient collaterals to the liver and spleen.
Aneurysm ; Embolization, Therapeutic ; Hepatic Artery ; Humans ; Liver ; Mesenteric Artery, Superior ; Middle Aged ; Spleen ; Splenic Artery

Zinc contained in the neurons of central nervous system is activity-dependently released and then attenuates NMDA (N-methyl-D-aspartate)-induced neurotoxicity while augmenting non-NMDA-induced neurodegeneration. Zinc also has been reported to produce antinociceptive action on the inflammation- and nerve injury-induced hyperalgesia in the behavioral test. In this study, we investigated the effects of zinc on the responses of dorsal horn cells to NMDA, kainate and graded electrical stimulation of C-fibers. In the majority of WDR cells (70.6%), zinc current-dependently inhibited WDR cell responses to NMDA and in the remaining cells, produced biphasic responses; excitation followed by inhibition. Zinc augmented the responses of WDR cells to iontophoretical application of kainate. The dominant effect of Zn2+ on the responses of WDR cells to C-fiber stimulation was excitatory, but inhibition, excitation-inhibition and no change of the responses to C-fiber stimulation were induced. Ca2+-EDTA antagonized the excitatory or inhibitory effects of Zn2+ on the WDR cell responses. These experimental findings suggest that Zn2+ modulates the transmission of sensory information in the rat spinal cord.
Animals ; Central Nervous System ; Electric Stimulation ; Excitatory Amino Acids* ; Hyperalgesia ; Kainic Acid ; N-Methylaspartate ; Neurons ; Posterior Horn Cells* ; Rats* ; Spinal Cord ; Zinc

OBJECTIVE: To evaluate the standards of handicapped driver's ability test in Korea and available driving aids in cervical cord injured persons. METHOD: Forty-two cervical cord injured persons (C5~C8) were evaluated with BTE (Baltimore Therapeutic Equipment) work simulator. The isotonic turning torque was measured during clockwise and counter-clockwise turning. And isometric turning torque was measured at 12 directions. RESULTS: By the isotonic measurement, the turning torque increased in the lower level of injury. In the C6 tetraplegics, the counter-clockwise turning torque was significantly higher than clockwise. Among 25 persons with C5 or C6 tetraplegia, only 2 with C6 tetraplegia could operate the power steering with the lowest wheel turning torque (3.0 Nm). Only three persons (1 person with C7 tetraplegia, 2 persons with C8 tetraplegia) could pass the handicapped driver's ability test of Korea (9.4 Nm). By the isometric measurement, turning torque was lowest at left upper quadrant (10 to 12 o'clock direction) in clockwise rotation. CONCLUSION: Among the 42 cervical cord injured persons, only 3 persons with C7 and C8 tetraplegia could pass the handicapped driver's ability test of Korea. And among 25 C5 and C6 tetraplegia, only 2 persons with C6 tetraplegia could operate the power steering. It seems to be essential to modify the standards of handicapped drivers ability test and to evolve the driving aids for the C5 and C6 tetraplegics in Korea.
Disabled Persons ; Humans ; Korea ; Quadriplegia ; Torque*